HomeMy WebLinkAboutKIRK LT 3l:
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~¢~¥$~/~ ~ ~¢¢&£Oi~ MAILING ADDRESS 94~ Spv~ ~A, PHONE
LEGAL D ESC R I PT I O ~~'-~J~'~ ~'~'~' :~:
LOCATION H,
SEPTIC TANK:
DISTANCE
FROM WELl
INSIDE LENGTH
NUMBER OF
INSIDE WIDTH .LIQUID DEPTH LIQUID CAPACITY I~00 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS
DIAMETER --
OR WIDTH ]'~' ,
LINING MATERIAL
CRIB SIZE: DIAMETER__
BUILDING FOUNDATION '~-~¢, NEAREST LOT LINE
ADDITIONAL ABSORPTION
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION -- LOT LINE SEWER LINE
CESSPOOL. OTHER SOURCES
APPROVED DISAPPROVED REMARKS
LENGTH ~/'/, DEPTH
.DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~O~-
SQ. ft,
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
Form No. EQ.031
DIAGRAM OF SYSTEM
DATE
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COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
C&M ENGINEERING
CHARLES BALZARINI, PE 6/14/24
��=Q3A Y asi �� a
Water Quality Testing
��e7l.OGl, 9131 E Frontage Rd, Ste 15
Palmer, AK 99645
(907)745-3005
matsutestiob.office@qmaii.com
Name:
C & M Engineering
Mailing Address:
20182 Tulwar Drive
Time Sampled:
Chugiak, AK 99567
Legal Description:
30355 Eagle River Rd
Sample Site Location:
Ext Spigot U
Health Guard I
Lab ID#:
M230792
Date Sampled:
08/08/2023
Time Sampled:
1705
Sampled By:
CB
Date Received:
08/09/2023
Time Received:
1238
Parameter
Method
Result
Unit
MRL
MCL
Date
Colilert
Total Coliforms
A
---
---
---
08/10/2023
SM 9223B
Colilert
E. coli
A
---
---
---
08/10/2023
SM 9223B
Total
TNTplus 835/836
0.831
mg/L
0.200
10.0
08/16/2023
Nitrate/Nitrite — N
Hach 10206
Arsenic
Arsenic by ASV
<MRL
µg/L
1.000
10
08/16/2023
Metrohm AB 416/3
Method Reporting Limit (MRL): the lowest concentration that can be reported reliably
Maximum Contaminant Level (MCL): highest acceptable level in public water systems as set by EPA
mg1L: milligrams per liter; 1/1000' of a gram
,ug/L: micrograms per liter; 1/1,000,000" of a gram
Absent (A): none of this type of bacteria was detected
Present (P): one or more bacterial cells of this type were detected
Results Reported By:
Patience Obermann
Laboratory Analyst
Reviewed By:
Z- gime 'U
Lynn Hill(Aug 17,202315:18AKDT)
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LOT 13
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Lot 3
Kirk Subdivision
105,910 Sq. Ft. +/-
30655 Sagwon Ave
2 Story Wood Frame House
No Garage
℄ SA
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PROFESSIONAL SEAL
Date:Frontier Surveys, LLC Project No:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Rachel Shoemake, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
June 26th, 2024.
Legend:
Scale 1" = 80'
Gas Meter
Electric Meter/Outside Power
Deck
Septic
Telephone Pole
Overhead Utility
Lot 3 Kirk Subdivision
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
Derek Livengood
24-142 07/09/2024
86-210 SE0703
Water Well
G
E
S W
Culvert
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYORRachel N. Shoemake
No. L.S. - 14646
Jul 30, 2024
Plastic Pipes
